| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
1,744 |
1,705 |
$164K |
| D1110 |
Prophylaxis - adult |
3,554 |
3,507 |
$125K |
| D0274 |
Bitewings - four radiographic images |
3,403 |
3,359 |
$93K |
| D1351 |
Sealant - per tooth |
3,419 |
618 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
3,541 |
3,478 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,165 |
683 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,017 |
572 |
$52K |
| D0330 |
Panoramic radiographic image |
1,310 |
1,296 |
$45K |
| D1120 |
Prophylaxis - child |
1,386 |
1,356 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,508 |
1,493 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
4,562 |
4,477 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,098 |
4,030 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
288 |
222 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,074 |
1,046 |
$19K |
| D1330 |
|
2,820 |
2,776 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
881 |
871 |
$16K |
| D9110 |
|
367 |
355 |
$11K |
| D0272 |
Bitewings - two radiographic images |
553 |
544 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
176 |
172 |
$6K |
| D1320 |
|
254 |
241 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
30 |
$2K |
| D0270 |
|
162 |
155 |
$1K |